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Adamu AA, Ndwandwe D, Jalo RI, Wiysonge CS. Positioning implementation science in national immunization programmes to improve coverage equity and advance progress toward Immunization Agenda 2030: An urgent global health imperative. Hum Vaccin Immunother 2024; 20:2331872. [PMID: 38556477 PMCID: PMC10984125 DOI: 10.1080/21645515.2024.2331872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
Despite the availability of effective vaccines for preventing common childhood infectious diseases, there is still significant disparities in access and utilization across many low- and middle-income countries (LMIC). The factors that drive these disparities are often multilevel, originating from individuals, health facilities, health systems and communities, and also multifaceted. Implementation science has emerged as a field to help address "know-do" gaps in health systems, and can play a significant role in strengthening immunization systems to understand and solve implementation barriers that limit access and uptake within their contexts. This article presents a reflexive perspective on how to position implementation research in immunization programmes to improve coverage equity. Furthermore, key points of synergy between implementation research and vaccination are highlighted, and some potential practice changes that can be applied within specific contexts were proposed. Using a human rights lens, it was concluded that the cost that is associated with implementation failure in immunization programmes is significant and unjust, and future directions for implementation research to optimize its application in practice settings have been recommended.
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Affiliation(s)
- Abdu A. Adamu
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Rabiu I. Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Brazzaville, Congo
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Adamu AA, Jalo RI, Muhammad ID, Essoh TA, Ndwandwe D, Wiysonge CS. Sustainable financing for vaccination towards advancing universal health coverage in the WHO African region: The strategic role of national health insurance. Hum Vaccin Immunother 2024; 20:2320505. [PMID: 38414114 PMCID: PMC10903629 DOI: 10.1080/21645515.2024.2320505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
There is a growing political interest in health reforms in Africa, and many countries are choosing national health insurance as their main financing mechanism for universal health coverage. Although vaccination is an essential health service that can influence progress toward universal health coverage, it is not often prioritized by these national health insurance systems. This paper highlights the potential gains of integrating vaccination into the package of health services that is provided through national health insurance and recommends practical policy actions that can enable countries to harness these benefits at population level.
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Affiliation(s)
- Abdu A. Adamu
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rabiu I. Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ibrahim D. Muhammad
- Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Téné-Alima Essoh
- Agence de Médecine Préventive, Regional Office for Africa, Abidjan, Cote d’Ivoire
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Brazzaville, Congo
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Ismail HT, Amole TG, Tsiga-Ahmed FI, Jalo RI, Adamu AL, Sani MU, Salihu HM, Wester CW, Aliyu MH. Factors Associated with Utilization of Sexual and Reproductive Health Services among Married Adolescent Girls in Kano, Northern Nigeria. Int J MCH AIDS 2024; 13:e001. [PMID: 38694894 PMCID: PMC11008586 DOI: 10.25259/ijma_13_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/25/2024] [Indexed: 05/04/2024] Open
Abstract
Background and Objective Married adolescents face significant obstacles in making informed reproductive health decisions and accessing sexual and reproductive health (SRH) services. It is important to identify barriers hindering these adolescents from accessing SRH services. The aim of this study was to identify factors associated with the utilization of SRH services among married adolescent girls in northern Nigeria. Methods We used a cross-sectional study design. The study population comprised of married female adolescents aged 14-19 years who were residents in the study areas for at least six months. The outcome measure was SRH service utilization, defined as the use of any of the conventional SRH services (ante/postnatal care, human immunodeficiency virus (HIV) testing and counseling, sexually transmitted infections (STI) treatment, family planning, and post-abortion care). Predictor variables included the sociodemographic, obstetric, and gynecological characteristics of the respondents. An adapted, pretested, interviewer-administered, and semi-structured questionnaire was employed for data collection. Multivariable logistic regression was used to explore the independent association between selected variables and utilization of SRH services. Results A total of 200 respondents were surveyed (100 each from an urban and a rural community in Kano, Nigeria), survey response rate: 94.5%. The age of respondents ranged from 14 to 19 years, with mean age (± standard deviation) of 18.5 (±1.1) years and 17.5 (±1.3) years for urban and rural respondents, respectively. All respondents were aware of the available SRH facilities and preferred public facilities (92.6% urban respondents and 67.0% rural respondents). Ever-use of SRH services was higher among urban than rural respondents (86% vs. 56%, respectively). Geographic proximity was a key factor for urban respondents (64.2%), while affordability was considered important by rural respondents (47.9%). Respondent's age and partner's occupation were independently associated with utilization of SRH services. Urban respondents whose husbands were businessmen were seven times more likely to use SRH services than those whose partners were civil servants (adjusted odds ratio [aOR] = 6.80, 95% confidence interval [CI]: 1.29-35.84, P = 0.02). Rural respondents 18 years of age and older were approximately six times more likely to utilize SRH services than those <18 years (aOR = 5.71, 95% CI: 1.56-12.78, P = 0.01). Conclusion and Global Health Implications Awareness of available SRH services was high in the study population, and service utilization was influenced by the respondent's age and partner's occupation. Findings from this study can help inform the development of age-appropriate and accessible SRH services tailored to married adolescents in similar settings.
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Affiliation(s)
- Hasiya T. Ismail
- Department of Community Medicine and Primary Care, Bayero University, Kano, Nigeria
| | - Taiwo G. Amole
- Department of Medicine, Bayero University, Kano, Nigeria
| | | | - Rabiu I. Jalo
- Department of Medicine, Bayero University, Kano, Nigeria
| | | | - Mahmoud U. Sani
- Office of the CEO, Kano Independent Research Centre Trust, Kwanar Dawaki, Kano, Nigeria
| | - Hamisu M. Salihu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, United States
| | - C. William Wester
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, United States
| | - Muktar H. Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, United States
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Adamu AA, Jalo RI, Ndwandwe D, Wiysonge CS. Informal health sector and routine immunization: making the case for harnessing the potentials of patent medicine vendors for the big catch-up to reduce zero-dose children in sub-Saharan Africa. Front Public Health 2024; 12:1353902. [PMID: 38515595 PMCID: PMC10956693 DOI: 10.3389/fpubh.2024.1353902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
The COVID-19 pandemic caused a surge in the number of unimmunized and under-immunized children in Africa. The majority of unimmunized (or zero-dose) children live in hard-to-reach rural areas, urban slums, and communities affected by conflict where health facilities are usually unavailable or difficult to access. In these settings, people mostly rely on the informal health sector for essential health services. Therefore, to reduce zero-dose children, it is critical to expand immunization services beyond health facilities to the informal health sector to meet the immunization needs of children in underserved places. In this perspective article, we propose a framework for the expansion of immunization services through the informal health sector as one of the pillars for the big catch-up plan to improve coverage and equity. In African countries like Nigeria, Ethiopia, Tanzania, and the Democratic Republic of Congo, patent medicine vendors serve as an important informal health sector provider group, and thus, they can be engaged to provide immunization services. A hub-and-spoke model can be used to integrate patent medicine vendors into the immunization system. A hub-and-spoke model is a framework for organization design where services that are provided by a central facility (hub) are complimented by secondary sites (spokes) to optimize access to care. Systems thinking approach should guide the design, implementation, and evaluation of this model.
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Affiliation(s)
- Abdu A. Adamu
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rabiu I. Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Djoué, Brazzaville, Republic of Congo
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Amole TG, Ayaba AK, Tsiga-Ahmed FI, Jalo RI, Bashir U, Adamu AL, Abu SM, Mahmud FM, Galadanci HS. Infection Prevention and Control: Baseline Knowledge and Practices of TBAs in Rural Kano, Northwestern Nigeria. West Afr J Med 2024; 41:175-182. [PMID: 38581696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
BACKGROUND Maternal infections remain a significant contributor to maternal mortality worldwide. Majority of births in northern Nigeria occur at home and are attended by Traditional Birth Attendants (TBAs). Little has been documented about their knowledge and practice on infection prevention and control practices in Kano, northern Nigeria. OBJECTIVES This study evaluated the level as well as factors associated with TBAs' infection prevention and control knowledge and practices. METHODS The study is the baseline phase of a quasi-experimental study, conducted in a rural LGA in Kano State, Nigeria. Using an adapted tool, 163 eligible TBAs were surveyed. Knowledge and practice of IPC were scored, aggregated, and dichotomized into good or poor. Binary logistic regression analysis was used to predict knowledge and practice of IPC. RESULTS Majority (79.1%) of the TBAs exhibited poor IPC knowledge but many (78.5%) reported good practice. Good knowledge of IPC was predicted by the TBAs' age: a six-fold increased likelihood (AOR=6.25, 95% CI: 1.02- 38.53) and almost five-fold increased likelihood (AOR=4.75, 95% CI: 1.39- 16.24) for those in their second and fourth decades of life. TBAs who reported poor practice of IPC were 83% less likely (AOR=0.17, 95% CI: 0.03- 0.92) to have good knowledge of IPC. TBAs' practice was only linked to previous training (AOR=0.17, 95% CI: 0.04- 0.76). CONCLUSION TBAs knowledge of IPC was low although reported practice was good. The need for tailored training interventions to enhance knowledge and skills for safe delivery care is paramount to improve maternal and neonatal outcomes.
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Affiliation(s)
- T G Amole
- Department of Community Medicine, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria
- Africa Center of Excellence for Population Health and Policy, Bayero University, Kano. Tel: +2347048413660
| | - A K Ayaba
- Department of Community Medicine, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - F I Tsiga-Ahmed
- Department of Community Medicine, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - R I Jalo
- Department of Community Medicine, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - U Bashir
- Department of Community Medicine, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - A L Adamu
- Department of Community Medicine, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - S M Abu
- Africa Center of Excellence for Population Health and Policy, Bayero University, Kano. Tel: +2347048413660
| | - F M Mahmud
- Africa Center of Excellence for Population Health and Policy, Bayero University, Kano. Tel: +2347048413660
| | - H S Galadanci
- Africa Center of Excellence for Population Health and Policy, Bayero University, Kano. Tel: +2347048413660
- Department of Obstetrics and Gynaecology, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria
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Adamu AA, Jalo RI, Ndwandwe D, Wiysonge CS. Assessing the Implementation Determinants of Pilot Malaria Vaccination Programs in Ghana, Kenya, and Malawi through a Complexity Lens: A Rapid Review Using a Consolidated Framework for Implementation Research. Vaccines (Basel) 2024; 12:111. [PMID: 38400095 PMCID: PMC10892876 DOI: 10.3390/vaccines12020111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/25/2024] Open
Abstract
In 2019, national immunization programs in Ghana, Kenya, and Malawi commenced the implementation of RTS,S/AS01 vaccination in large-scale pilot schemes. Understanding the implementation context of this malaria vaccination in the pilot countries can provide useful insights for enhancing implementation outcomes in new countries. There has not yet been a proper synthesis of the implementation determinants of malaria vaccination programs. A rapid review was conducted to identify the implementation determinants of the pilot malaria vaccination programs in Ghana, Kenya, and Malawi, and describe the mechanism by which these determinants interact with each other. A literature search was conducted in November 2023 in PubMed and Google Scholar to identify those studies that described the factors affecting malaria vaccine implementation in Ghana, Kenya, and Malawi. Thirteen studies conducted between 2021 and 2023 were included. A total of 62 implementation determinants of malaria vaccination across all five domains of the consolidated framework for implementation research (CFIR) were identified. A causal loop diagram showed that these factors are interconnected and interrelated, identifying nine reinforcing loops and two balancing loops. As additional countries in Africa prepare for a malaria vaccine roll-out, it is pertinent to ensure that they have access to adequate information about the implementation context of countries that are already implementing malaria vaccination programs so that they understand the potential barriers and facilitators. This information can be used to inform context-specific systems enhancement to maximize implementation success. Going forward, primary implementation studies that incorporate the causal loop diagram should be integrated into the malaria vaccine implementation program to enable immunization program managers and other key stakeholders to identify and respond to emerging implementation barriers in a timely and systematic manner, to improve overall implementation performance.
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Affiliation(s)
- Abdu A. Adamu
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parrow Valley, Cape Town 7500, South Africa; (D.N.); (C.S.W.)
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Rabiu I. Jalo
- Department of Community Medicine, Faculty of Clinical Sciences, Bayero University Kano, inside Aminu Kano Teaching Hospital, along Zaria Road, Kano 700233, Nigeria;
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parrow Valley, Cape Town 7500, South Africa; (D.N.); (C.S.W.)
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parrow Valley, Cape Town 7500, South Africa; (D.N.); (C.S.W.)
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Communicable and Non-Communicable Diseases Cluster, World Health Organization Regional Office for Africa, Djoue, Brazzaville BP 06, Congo
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Adamu AA, Essoh TA, Jalo RI, Wiysonge CS. Toward political economy of sustainable financing for immunization in the World Health Organization African Region through a systems thinking lens. Int J Infect Dis 2023; 136:158-161. [PMID: 37774773 DOI: 10.1016/j.ijid.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023] Open
Abstract
There is an urgent need for countries in Africa to allocate more domestic financial resources to immunization so that national immunization programmes can attain self-reliance in line with World Health Organization's Immunization Agenda 2030. However, resource allocation is fundamentally a political process because other competing needs exist. Political economy analysis (PEA) can guide policy influencers in their engagement with decision makers to tilt their interest in support of sustainable immunization financing. PEA can provide a deeper understanding of the potential constraints and facilitators of a policy direction to expand the fiscal space for immunization using domestic resources within the context of a country's socioeconomic and political realities. To further advance the usefulness of PEA for decision making, a systems thinking lens should be applied to account for the inherent complexity of the social systems involved in resource allocation and implementation. Several methods and tools of systems thinking already exist and can be employed. Causal loop diagrams, when incorporated in a PEA of sustainable financing for immunization can aid the identification of feedback loops which can be used as leverage points for intervention.
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Affiliation(s)
- Abdu A Adamu
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, 7505, Tygerberg, Cape Town, South Africa; Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Parow Valley, 7505, Tygerberg, Cape Town, South Africa.
| | - Téné-Alima Essoh
- Agence de Médecine Préventive, Bureau Regional Afrique, 08 BP 660, Cocody II, Abidjan, Cote d'Ivoire
| | - Rabiu I Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Along Zaria Road, Kano City, Kano, Nigeria
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, 7505, Tygerberg, Cape Town, South Africa; Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Parow Valley, 7505, Tygerberg, Cape Town, South Africa; Communicable and Non-Communicable Diseases Cluster, World Health Organization Regional Office for Africa, Djoue, BP 06, Brazzaville, Congo
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Usman F, Farouk ZL, Tsiga-Ahmed FI, Abdussalam M, Jalo RI, Mohammad SS, Aliyu MH. Improvised bubble continuous positive airway pressure ventilation use in neonates in resource-limited settings: a systematic review and meta-analysis. J Perinat Med 2023; 51:840-849. [PMID: 35263514 DOI: 10.1515/jpm-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/14/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In the face of limited fiscal and technical resources, improvised methods have been used to provide effective and sustainable ventilatory support in low-resource settings to reduce neonatal mortality associated with respiratory complications. This study assessed the use of improvised bubble continuous positive airway pressure (ibCPAP) ventilation among neonates with respiratory complications and determined its effect on neonatal outcomes in low- and middle-income countries (LMICs). CONTENT Hospital-based studies conducted between 2010 and 2020 in LMICs were reviewed. Rayyan® software for systematic review was used for screening and article selection. We used Stata® Statacorp Texas USA software to estimate pooled prevalence, proportion estimates, weighted mean differences and 95% Confidence Interval (CI), using the random effects model. SUMMARY A total of 193 articles were generated and 125 were reviewed. Thirteen articles with 806 neonates on ibCPAP ventilation were included. The pooled prevalence of ibCPAP use was 7.0% (95% CI: 3.0%-13.0%). There was a significant difference in mean oxygen saturation before and after ibCPAP use (-1.34% [95% CI: -1.65% to -1.02%, p<0.01). The duration of oxygen requirement among neonates on ibCPAP was 6.5 hours less than controls (0.27 days [95%CI: -0.49 to -0.05, p<0.01). OUTLOOK IbCPAP had no effect on the respiratory rate, duration of admission, mortality and survival. IbCPAP use in LMIC hospitals is low and its use improved oxygen saturation and duration on oxygen among the neonates, but had no impact on length of stay, respiratory rate, mortality or survival.
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Affiliation(s)
- Fatima Usman
- Department of Pediatrics, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Zubaida L Farouk
- Department of Pediatrics, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Fatimah I Tsiga-Ahmed
- Department of Community Medicine, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Muhammed Abdussalam
- Department of Pediatrics, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Rabiu I Jalo
- Department of Community Medicine, Bayero University, Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, USA
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Tukur AR, Mahmud A, Jibril YN, Jalo RI, Salisu AD. Allergic rhinitis: An indicator of otitis media with effusion in children seen at aminu kano teaching hospital, Kano. Niger J Clin Pract 2022; 25:1725-1730. [PMID: 36308246 DOI: 10.4103/njcp.njcp_206_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Allergic rhinitis (AR) is a multifocal IgE-mediated type I hypersensitivity reaction involving nasal mucosa characterized by excessive sneezing, watery rhinorrhea, nasal itching, nasal stuffiness, and eyes itching. Tympanometry is a simple, rapid, and objective test that can be easily carried out. The use of tympanometry in clinical setting can improve detection of middle ear effusion and other middle ear abnormalities. AR has been found to be one of the predisposing factors to developing Otitis Media with Effusion (OME) in children. PATIENTS AND METHODS A case-control study was used to determine the prevalence of OME among children with AR as cases and those without allergy as controls. The study participants were children aged 4-12 years with clinical diagnosis of AR attending ENT clinics of Aminu Kano Teaching Hospital, whereas controls were children age 4-12 years without history of AR, ear diseases, or other respiratory system related ailments attending general outpatient clinics in Aminu Kano Teaching Hospital. An interviewer-administered score for AR (SFAR) questionnaire was filled out for all the participants, those with score of 6 and above were selected as cases. The two groups had complete ENT examination and tympanometry done, findings were recorded, and analyzed using SPSS version 21. RESULTS The mean age of the cases was 6.8 ± 2.1 years, whereas it was 7.5 ± 2.6 years for the controls. The mean difference was 0.7 and was not statistically significant (t = 2.35, df = 258, P value = 0.20). Type B tympanogram suggesting OME was found in 7.3% of subjects and in 2.8% of controls. Type C tympanogram suggesting negative middle ear pressure was found in 15.5% of subjects and in 4.6% of controls. Type A tympanogram suggesting normal middle ear pressure was found in 75% of subjects and in 90% of controls. Acoustic reflex was found to be absent in 29.6% of subjects and in 15.4% of controls and this found to be statistically significant (χ2 = 7.77, df = 1, P value = 0.001). The difference between type A, B, and C tympanograms of subjects and that of controls was found to be statistically significant (Type A χ2 = 14.62, df = 4, P value = 0.01, Type B χ2 = 14.06, df = 4, P value = 0.01, Type C χ2 = 17.01, df = 6, P value = 0.01). Type B tympanogram was used as an indicator to suggest OME for the purpose of this study. CONCLUSION Participants with AR were found to have more abnormalities of tympanometric parameters and higher prevalence of type B tympanogram suggesting OME than controls.
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Affiliation(s)
- A R Tukur
- Department of ENT, Aminu Kano Teaching Hospital/Bayero University Kano, Kano, Nigeria
| | - A Mahmud
- Department of ENT, Federal Medical Centre Yola, Adamawa, Kano, Nigeria
| | - Y N Jibril
- Department of Otolaryngology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - R I Jalo
- Department of Community Medicine, Aminu Kano Teaching Hospital/Bayero University Kano, Nigeria
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Tsiga-Ahmed FI, Jalo RI, Ibrahim UM, Kwaku AA, Umar AA, Sanusi SM, Amole TG. Length-of-stay after a health facility birth and associated factors: analysis of data from three Sub-Saharan African countries. Ghana Med J 2022; 56:100-109. [PMID: 37449254 PMCID: PMC10336462 DOI: 10.4314/gmj.v56i2.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVES We estimated the length-of-stay (LOS) in the health facility after childbirth and identified associated factors in three sub-Saharan African countries. DESIGN Secondary analysis using data from the most recent Multiple Indicator Cluster Surveys. SETTING Multiple Indicator Cluster Surveys from Ghana, Malawi and Eswatini were selected. PARTICIPANTS Women aged 15-49 years who had a facility delivery in the two years preceding the survey were included. MAIN OUTCOME MEASURES Length-of-stay recorded in days and weeks were converted to hours and analysed as a continuous variable. RESULTS Length-of-stay was estimated for 9147 women, wherein 6610 women (median LOS and IQR: 36 36,60 hours), 1698 women (median LOS and IQR 36 10,60 hours) and 839 women (median-length-stay 36 36,60 hours) were from Malawi, Ghana and Eswatini respectively. Being from Ghana [RC, -20.6 (95%CI:-25.2 - -16.0)] and then Eswatini [RC: -13.0 (95%CI: -19.9 - -9.8)] and delivery in a government hospital [RC: -4.9 (95%CI -9.9- -0.3)] were independently associated with having a shorter LOS. Having a caesarean section, assistance by Nurses/Midwives or Auxiliaries/CHOs, single birth, heavier birth weight, and death of newborn before discharge increased the duration of stay. CONCLUSIONS Necessitating and facility factors are important determinants of length of stay. Socio-demographic characteristics, however, have a restricted role in influencing the duration of postpartum stay in sub-Saharan Africa. Further prospective research is required to identify more determinants and provide evidence for policy formulation and clinical guidelines regarding the safest time for discharge after delivery. FUNDING None declared.
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Affiliation(s)
- Fatimah I Tsiga-Ahmed
- Department of Community Medicine, College of Health Sciences, Bayero University Kano, Nigeria
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Rabiu I Jalo
- Department of Community Medicine, College of Health Sciences, Bayero University Kano, Nigeria
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Usman M Ibrahim
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Aminatu A Kwaku
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Amina A Umar
- Department of Community Medicine, College of Health Sciences, Bayero University Kano, Nigeria
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Surayya M Sanusi
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Taiwo G Amole
- Department of Community Medicine, College of Health Sciences, Bayero University Kano, Nigeria
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
- African Centre of Excellence for Population Health and Policy, Bayero University Kano, Nigeria
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11
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Mahmud A, Salisu AD, Kolo ES, Hasheem MG, Bello‐Muhammad N, Tukur AR, Nuhu YJ, Jalo RI. Impact of smoking on nasal mucociliary clearance time in Kano metropolis, Nigeria. World J Otorhinolaryngol Head Neck Surg 2022; 9:53-58. [PMID: 37006746 PMCID: PMC10050968 DOI: 10.1002/wjo2.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 11/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Mucociliary clearance is an important defense mechanism in human upper and lower respiratory airways. Impairment of this process by certain conditions such as cigarette smoking can predispose to chronic infection and neoplasm of the nose and paranasal sinuses. Methods This was a cross-sectional study conducted in Kano metropolis, Nigeria. Eligible adults were enrolled, a saccharine test was conducted, and the nasal mucociliary clearance time was assessed. Analysis of the result was carried out using Statistical Product and Service Solutions version 23.0. Results There were 225 participants categorized into 75 active smokers (33.3%), 74 passive smokers (32.9%), and 76 nonsmokers (33.8%, living in a smoking-free zone). The age range of the participants was between 18 and 50 years, with a mean age of (31.2 ± 5.6) years. All participants were males. There were 139 (61.8%) of Hausa-Fulani ethnic group, 24 (10.7%) Yoruba, 18 (8.0%) Igbo, and 44 (19.5%) other ethnic groups. Findings in this study showed that the average mucociliary clearance time among active smokers was prolonged ([15.25 ± 6.20] min) compared to passive ([11.41 ± 4.25] min) and nonsmokers ([9.17 ± 2.76] min) respectively, with a statistical significance (F = 33.59, P < 0.001). Binary logistic regression revealed that the number of cigarettes smoked per day was an independent predictor of prolonged mucociliary clearance time (P = 0.008, odds ratio = 0.44, 95% confidence interval = 0.24-0.80). Conclusion Active cigarette smoking is associated with prolonged nasal mucociliary clearance time. The number of cigarette sticks smoked per day was found to be an independent predictor of prolonged mucociliary clearance time.
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Affiliation(s)
- Ahmad Mahmud
- Department of ENT Federal Medical Centre Yola Yola Nigeria
- Department of ENT Aminu Kano Teaching Hospital Kano Nigeria
| | - Abubakar D. Salisu
- Department of ENT, Aminu Kano Teaching Hospital Bayero University Kano Kano Nigeria
| | - Emmanuel S. Kolo
- Department of ENT, Aminu Kano Teaching Hospital Bayero University Kano Kano Nigeria
| | - Muhammad G. Hasheem
- Department of ENT, Aminu Kano Teaching Hospital Bayero University Kano Kano Nigeria
| | | | - Ahmad R. Tukur
- Department of ENT, Aminu Kano Teaching Hospital Bayero University Kano Kano Nigeria
| | - Yasir J. Nuhu
- Department of ENT, Aminu Kano Teaching Hospital Bayero University Kano Kano Nigeria
| | - Rabiu I. Jalo
- Department of ENT, Aminu Kano Teaching Hospital Bayero University Kano Kano Nigeria
- Department of Community Medicine Aminu Kano Teaching Hospital/Bayero University Kano Kano Nigeria
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12
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Adamu AA, Essoh TA, Adeyanju GC, Jalo RI, Saleh Y, Aplogan A, Wiysonge CS. Drivers of hesitancy towards recommended childhood vaccines in African settings: a scoping review of literature from Kenya, Malawi and Ethiopia. Expert Rev Vaccines 2021; 20:611-621. [PMID: 33682587 DOI: 10.1080/14760584.2021.1899819] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION There is a dearth of literature on vaccine hesitancy in Africa. In this study, we aimed to explore the drivers of hesitancy toward recommended childhood vaccines in Kenya, Malawi, and Ethiopia. METHODS A scoping review methodology was used as this evidence synthesis approach is suitable for mapping existing literature and identifying knowledge gaps. For this study, we systematically searched four electronic databases for published and unpublished literature from the three African countries. The methodological framework that was used is in line with Arksey and O'Malley's recommendations as modified by Levac. RESULTS A total of 23 publications met the inclusion criteria and were included in the study. Majority of the studies were published after 2012. In these three African countries, hesitancy toward recommended childhood vaccines is driven by a mix of caregiver-related factors, health systems-related factors as well as the influence of community context. CONCLUSION This study demonstrated that vaccine hesitancy in Kenya, Malawi, and Ethiopia is a complex phenomenon that is driven by multiple interrelated and interconnected factors.
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Affiliation(s)
- Abdu A Adamu
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Téné-Alima Essoh
- Agence De Médecine Préventive (AMP) Afrique - Preventive Medicine Agency Africa, Abidjan, Cote d'Ivoire
| | - Gbadebo Collins Adeyanju
- Psychology and Infectious Diseases Lab, Department of Media and Communication Science, Faculty of Philosophy, University of Erfurt, Erfurt, Germany.,Centre for Empirical Research in Economics and Behavioural Science (CEREB), University of ErfurtErfurt, Germany
| | - Rabiu I Jalo
- Department of Community Medicine, Faculty of Clinical Sciences, College of Health Science, Bayero University Kano, Kano State, Nigeria.,Department of Community Medicine, Aminu Kano Teaching Hospital, Kano State, Nigeria
| | - Yusuf Saleh
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano State, Nigeria
| | - Aristide Aplogan
- Agence De Médecine Préventive (AMP) Afrique - Preventive Medicine Agency Africa, Abidjan, Cote d'Ivoire
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa
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13
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Iliyasu Z, Galadanci HS, Zubair KA, Abdullahi HM, Jalo RI, Aliyu MH. Fertility desire concordance and contraceptive use among couples living with HIV in northern Nigeria. EUR J CONTRACEP REPR 2020; 25:372-380. [PMID: 32880492 DOI: 10.1080/13625187.2020.1807499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We aimed to determine the concordance between own and perceived partner fertility intentions and identify predictors of contraceptive use among couples receiving antiretroviral therapy in Kano, Nigeria. METHODS A structured, validated questionnaire was used to interview 399 married men and women receiving antiretroviral therapy. Adjusted odds ratios for predictors of contraceptive use were derived from multivariate logistic regression models. RESULTS Most couples (68.9%) had concordant fertility intentions. Only 10.0% of couples had discordant fertility intentions. Among 232 couples (58.1%) at least one partner used contraception. Male condoms were used by 45.9% of couples (n = 183). Female methods were used by 175 couples (43.9%). Contraceptive use was significantly higher in participants who were older (≥30 years), better educated (secondary or post-secondary), had a higher monthly income (NGN ≥30,000), longer marriage duration (≥5 years), at least one living child, >1 year of antiretroviral treatment, and who were living with a serodiscordant partner and in circumstances where the decision on contraception was made by the female partner or jointly by both partners (all p < 0.05). Contraceptive use was significantly lower in participants who had not been sexually active in the last 6 months, where both partners wanted more children, and in situations lacking spousal communication about family planning (all p < 0.05). CONCLUSION One in 10 couples had discordant fertility intentions. Contraceptive use was suboptimal and was predicted by age, education, income, length of marriage, number of children, duration of antiretroviral therapy, partner's serostatus, sexual activity, fertility intention, spousal communication and the contraceptive decision-maker. Our findings highlight the need for spousal communication, joint contraceptive decision making and the integration of reproductive health services with antiretroviral therapy services.
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Affiliation(s)
- Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Hadiza S Galadanci
- Department of Obstetrics and Gynaecology, Bayero University, Kano, Nigeria
| | | | | | - Rabiu I Jalo
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Muktar H Aliyu
- Department of Health Policy, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
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14
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Adamu AA, Jalo RI, Habonimana D, Wiysonge CS. COVID-19 and routine childhood immunization in Africa: Leveraging systems thinking and implementation science to improve immunization system performance. Int J Infect Dis 2020; 98:161-165. [PMID: 32592908 PMCID: PMC7313512 DOI: 10.1016/j.ijid.2020.06.072] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/18/2020] [Accepted: 06/20/2020] [Indexed: 12/11/2022] Open
Abstract
One of the routine health services that is being disrupted by coronavirus disease 2019 (COVID-19) in Africa is childhood immunization. This is because the immunization system relies on functioning health facilities and stable communities to be effective. Its disruption increases the risk of epidemics of vaccine-preventable diseases, which could increase child mortality. Therefore, policymakers must quickly identify robust and context-specific strategies to rapidly scale-up routine immunization in order to mitigate the impact of COVID-19 on their national immunization performance. To achieve this, we propose a paradigm shift towards systems thinking and use of implementation science in immunization decision-making. Systems thinking can inform a more nuanced and holistic understanding of the interrelationship between COVID-19, its control strategies, and childhood immunization. Tools like causal loop diagrams can be used to explicitly illustrate the systems structure by identifying feedback loops. Once mapped and leverage points for interventions have been identified, implementation science can be used to guide the rapid uptake and utilization of multifaceted evidence-based innovations in complex practice settings. As Africa re-strategizes for the post-2020 era, these emerging fields could contribute significantly in accelerating progress towards universal access to vaccines for all children on the continent despite COVID-19.
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Affiliation(s)
- Abdu A Adamu
- Cochrane South Africa, South African Medical Research Council, Francie Van Zijl Drive, Parrowvallei, Tygerberg, 7505, Cape Town, South Africa; Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zijl Drive, Parrowvallei, Tygerberg, 7505, Cape Town, South Africa.
| | - Rabiu I Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Zaria Road, Kano State, Nigeria
| | - Desire Habonimana
- Research and Innovation Unit, Department of Community Medicine, Faculty of Medicine, University of Burundi, Bujumbura, Burundi
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Francie Van Zijl Drive, Parrowvallei, Tygerberg, 7505, Cape Town, South Africa; Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie Van Zijl Drive, Parrowvallei, Tygerberg, 7505, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Observatory, 7925, Cape Town, South Africa
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15
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Adamu AA, Gadanya MA, Jalo RI, Uthman OA, Wiysonge CS. Factors influencing non-prescription sales of antibiotics among patent and proprietary medicine vendors in Kano, Nigeria: a cross-sectional study. Health Policy Plan 2020; 35:819-828. [PMID: 32529246 DOI: 10.1093/heapol/czaa052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2020] [Indexed: 12/18/2022] Open
Abstract
Patent and proprietary medicine vendors (PPMVs) increase access to antibiotics through non-prescription sales in their drug retail outlets. This fosters irrational antibiotic use among people, thus contributing to the growing burden of resistance. Although training programmes on antibiotic use and resistance exist, they have disproportionately targeted health workers in hospital settings. It's unclear if there is a relationship between such trainings and non-prescription sales of antibiotics among PPMVs which are more embedded in communities. Therefore, a cross-sectional study was conducted to elicit the determinants of non-prescription antibiotic sales among PPMVs in Kano metropolis, Nigeria. Through brainstorming, causal loop diagrams (CLDs) were used to illustrate the dynamics of factors that are responsible for non-prescription antibiotic sales. Multilevel logistic regression model was used to determine the relationship between training on antibiotic use and resistance and non-prescription antibiotic sales, after controlling for potential confounders. We found that two-third (66.70%) of the PPMVs reported that they have sold non-prescribed antibiotics. A total of three CLDs were constructed to illustrate the complex dynamics of the factors that are related to non-prescription antibiotic sales. After controlling for all factors, PPMVs who reported that they had never received any training on antibiotic use and resistance were twice as more likely to sell antibiotic without prescription compared with those who reported that they have ever received such training (OR = 2.07, 95% CI: 1.27-3.37). This finding suggests that there is an association between training on antibiotic use and resistance and non-prescription sales of antibiotics. However, the complex dynamics of the factors should not be ignored as it can have implications for the development of intervention programmes. Multifaceted and multicomponent intervention packages (incorporating trainings on antibiotic use and resistance) that account for the inherent complexity within the system are likely to be more effective for this setting.
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Affiliation(s)
- Abdu A Adamu
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parrowvallei, 7505 Tygerberg, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Parrowvallei, 7505 Tygerberg, Cape Town, South Africa
| | - Muktar A Gadanya
- Department of Community Medicine, Bayero University College of Health Sciences/Aminu Kano Teaching Hospital, PMB 3011, Along Zaria Road, Kano State, Nigeria
| | - Rabiu I Jalo
- Department of Community Medicine, Bayero University College of Health Sciences/Aminu Kano Teaching Hospital, PMB 3011, Along Zaria Road, Kano State, Nigeria
| | - Olalekan A Uthman
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Parrowvallei, 7505 Tygerberg, Cape Town, South Africa.,Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, CV4 7HL, UK
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parrowvallei, 7505 Tygerberg, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Parrowvallei, 7505 Tygerberg, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, 7925 Observatory, Cape Town, South Africa
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16
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Adamu AA, Gadanya MA, Jalo RI, Uthman OA, Nnaji CA, Bello IW, Wiysonge CS. Assessing readiness to implement routine immunization among patent and proprietary medicine vendors in Kano, Nigeria: a theory-informed cross-sectional study. Expert Rev Vaccines 2020; 19:395-405. [PMID: 32238070 DOI: 10.1080/14760584.2020.1750379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patent and proprietary medicine vendors (PPMVs) are widespread in communities and can potentially be used to expand access to routine immunization especially in underserved areas. In this study, we aimed to assess their readiness to implement routine immunization in Kano, Nigeria and identify factors associated with it. METHODS We conducted a cross-sectional survey of PPMVs aged 18 years and above in Kano metropolis, Nigeria, using cluster sampling technique. A 10-item Likert scale-based measure was used to estimate readiness score. The relationship between selected factors and readiness score was examined using multilevel linear modeling technique. RESULTS A total of 455 PPMVs with median age of 36 years participated in the study. The median raw score for readiness was 4.7 (IQR: 4.3 - 4-8) (maximum obtainable was 5). The mean readiness score (obtained through factor analysis) was 5.28 (SD: 0.58). Readiness score was associated with factors such as knowledge of immunization and task demand, engagement by other public health programs among others. CONCLUSION This study demonstrated the feasibility of measuring the level of readiness for implementing routine immunization among PPMVs. Given the high level of readiness, policy makers should consider the possibility of expanding access to immunization through PPMVs.
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Affiliation(s)
- Abdu A Adamu
- Cochrane South Africa, South African Medical Research Council , Tygerberg, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa
| | - Muktar A Gadanya
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital , Kano, Nigeria
| | - Rabiu I Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital , Kano, Nigeria
| | - Olalekan A Uthman
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa.,Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School , Coventry, UK
| | - Chukwudi A Nnaji
- Cochrane South Africa, South African Medical Research Council , Tygerberg, South Africa.,School of Public Health and Family Medicine, University of Cape Town , Cape Town, South Africa
| | - Imam W Bello
- Department of Public Health and Disease Control, Kano State Ministry of Health , Kano, Nigeria
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council , Tygerberg, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town , Cape Town, South Africa
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